The predictive role of histopathological findings in renal insufficiency and complete remission in Iranian adults with primary focal segmental glomerulosclerosis

Objectives: to identify the histopathological findings that may act as possible predictors of complete remission or progression to chronic kidney disease in Iranian adults with primary focal segmental glomerulosclerosis (FSGS). Methods: In this historical cohort study, pathological findings of 50 patients with primary FSGS were reviewed by single renal pathologist without knowing about patient’s identities or outcomes. We divided the patients based on their histopathological findings, and compared the outcomes (renal insufficiency and complete remission) among these groups. Results: There were significant differences in the complete remission in subject with and without mesangial hypercellularity (p<0.05), and in patients with and without hyalinosis (p<0.05). According to the cut off points based on ROC curve analysis for the quantitative data, there was significant difference in renal insufficiency between the patients with and without global scars more than 12% (p<0.05).Also multiple logistic regression analysis strongly suggest the association of mesangial hypercellularity and global scar with no complete remission and progression to renal insufficiency, respectively. Conclusion: In the studied patients, presence of mesangial hypercellularity and hyalinosis have been suggested as prognostic factors for lower remission rate. According to multivariate analysis, only the presence of mesangial hypercellularity and global scar were found as independent prognostic predictors to lower complete remission rate and progression to renal insufficiency in patients with FSGS, respectively.